Mission Critical: Getting Vets With PTSD Back to Work

Vocational Rehabilitation Planning and Service Delivery Process

To facilitate employment success, the vocational rehabilitation team:

• Assesses the individual;

• Identifies social support systems, and

• Selects and implements the most promising practices for that individual.

Assess the individual. The plan must take into account the individual. Each person possesses a unique set of behaviors, attitudes, coping skills, occupational history, transferable work skills, and expectations. The vocational rehabilitation counselor will provide vocational evaluation, transferable skills analyses, and counseling to help the veteran understand the disability as well as the holistic perspective of his or her strengths.

The primary care team provides the vocation rehabilitation counselor with detailed information about functional limitations (physical, cognitive, and emotional) that will affect employment choices and workplace performance. Consideration should be given, for example, to the work-day structure (stable work hours, rest breaks, and medications that affect safety).

Assess the social support network. After veterans have an understanding of their disabilities and themselves in a return-to-work effort, the next step is to take into account the role of family, peers, and the overall community, including broader societal factors, such as labor market conditions.^[25]

Disabilities, such as PTSD, do not affect just the individual. Family members also experience a range of emotions and reactions to living with the disorder and the person who is now different. Emotions can range from anger to guilt and depression, resulting in sleep problems, substance abuse, and other health problems, as well as detachment.^[26,27] Understanding the impact of this disorder is integral to providing comprehensive care for the family, especially in the setting of a family medicine practice.

A return to civilian work from active service is often uncharted territory for veterans. The military offered structured work assignments, access to training, transportation to worksites, and frequent supervision. The expectations were clear and consistent from one work assignment to another. Family support was intricately interwoven into the service commitment. Civilian work and life, in contrast, can be less structured and harder to understand. The transition can be difficult for many veterans, especially for those who enlisted at age 18 years and have not yet experienced complete independence.

Primary care providers should provide the team with a thorough social history, including information about the veteran's support system. Evaluating the need for support services for the veteran and their family members is essential to the veteran's employment success. Every community is different, and determining what is available is the team's responsibility. These services may include demonstration programs, such as Community Circles of Support for Veterans' Families. The team can play a vital role in linking veterans and their family members to community resources and in providing referrals to support groups and other services.